Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS): Implications for Clinical Practice

The term pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) identifies a subset of children with infection-related obsessive compulsive disorders (OCD) or tic disorders that meet the following 5 criteria: (1) presence of OCD and/or a tic disorder, (2) prepubertal symptom onset, (3) episodic course of symptom severity, (4) association with group A β-hemolytic streptococcal (GAS) infection, and (5) association with neurological abnormalities.¹ Although not without controversy,² a mechanism similar to Sydenham chorea has been proposed for PANDAS, in which, in susceptible individuals, GAS infection triggers an antineuronal autoimmune response that negatively impacts striatal circuitry responsible for mediating OCD and tic symptoms.¹ Thus, PANDAS by definition assumes that symptom onset or exacerbation is etiopathologically associated with GAS.^3,4